Nonprofit excels at integrating mental, physical health care

Julio Arellano, right, and others participate in a tai chi class at the Asian Counseling and Referral Service (ACRS) in Rainier Valley.

Participants in the Wellness for Asian Pacific Americans project, which combines mental health treatment with physical health treatment, includes exercise movements and a dance class. These participants are members of Seattle’s Laotian community.

Participants in the Wellness for Asian Pacific Americans project, which combines mental health treatment with physical health treatment, includes exercise movements and a dance class.

The Filipino immigrant worked for years as a necktie cutter at a local factory before hurting his back, becoming increasingly depressed and hearing voices.

He became estranged from his family and ended up at Asian Counseling and Referral Service, a mental-health organization that provided medication and helped him build self-esteem through group therapy.

But Arellano, unable to afford insurance or speak English, also had not been to a primary-care doctor in years. So the organization sent him to one — down the hall.

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The doctor noticed something wrong and arranged for Arellano to see a cardiologist.

The next day, Arellano was in emergency surgery to reconstruct three heart valves.

“Asian Counseling and Referral Service was there when I needed it,” the 62-year-old said through a translator.

In Washington state and across the country, officials are talking about how to better integrate mental- and physical-health service to save money and lives.

In South Seattle, this organization is already doing it.

Asian Counseling and Referral Service (ACRS), one of 12 nonprofits assisted by The Seattle Times Fund For The Needy, serves more than 27,000 people annually through mental-health and substance-abuse programs, legal and naturalization help and one of the most-visited food banks in King County.

The organization, founded in 1973, now has an annual budget of $15 million.

Behavioral Health Director Yoon Joo Han said the project is aimed at fighting one fact: People with a severe mental illness die 25 years younger than everybody else, according to a 2006 study by the National Association of State Mental Health Program Directors.

That’s likely because mental conditions can lead some to neglect their physical health, and because psychiatric medications often carry side effects, Han said.

“The statistics say that people die at the age of 53 when you have chronic mental illness,” she said. “We wanted to do something to change that course.”

The results have surprised even the ACRS organizers.

Participants have recorded a 31 percent drop in cholesterol, 23 percent dip in blood pressure and 49 percent dive in body mass index, according to ACRS.

“We’ve moved the organization from being a mental-health organization to being a whole-health organization,” said ACRS Deputy Director Janet St. Clair. “We’re a health organization.”

Clients arrive at the project after being referred by other social-service providers or county officials, discovered by a case manager or coming in on their own.

Most participate in one of 23 themed wellness groups, from the Diabetes Prevention Group to the Tai-Chi Group.

One of those groups, the Lao Superstars, gathered on a recent Friday afternoon to dance to traditional Laotian music and eat (healthful) traditional Laotian food.

But first, they had to exercise.

As two dozen men and women moved through a variety of stretches, Noukone Meunsavang stepped aside to describe how the camaraderie of the group, which meets weekly, helps her to battle depression.

“We’re a family,” said Meunsavang, 51, who like most in the group had emigrated from Laos.

Many of the group members struggle with depression, said leader Sompasong Keohavong.

Moving around is key to combating it and associated problems
such as obesity and diabetes, said Keohavong, describing the Wellness for Asian Pacific American Project as a study in “how mental and physical and spiritual work together for the benefit of our bodies.”

Plus participants have access to primary-care doctors in the same building as their mental-health treatment.

Dan Copp, the doctor who noticed Julio Arellano’s heart problem, said he sees patients of all ages during the one day a week he spends at ACRS. Another doctor also spends a day there.

The physicians prescribe medication and offer advice on lifestyle changes. If more dramatic action is needed, they refer patients to a specialist.

Patients often have never seen an U.S. doctor before because of their mental-health condition, language or cultural barriers, or the expense, Copp said.

If a patient at ACRS can’t pay, the organization helps foot the bill.

Copp, who is employed by the nonprofit International Community Health Services and works with other mental-health providers, said ACRS is much more committed to communication.

“There’s usually not great — that’s putting it lightly — communication between myself and the mental-health providers,” Copp said. “It leaves a lot to be desired.”

The same could be said about Washington state’s mental-health system, officials acknowledge.

Last summer, the federal government ordered the state to open administration of its system, currently run by county bureaucracies, to private competition. As the state tries to decide how to respond by an early December deadline, some are hoping to use the opportunity to improve integration with other health programs.

“It’s an opportunity to maybe make some changes,” said state Rep. Dawn Morrell, chairwoman of the House Appropriations Subcommittee on Health & Human Services.

Morrell, D-Puyallup, said the focus now is on integrating mental-health and substance-abuse treatment. But ultimately, she said, the state will try to coordinate with physical health, too.

As for those already doing it, the ACRS says it hopes to expand its wellness project next year.